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Workers’ Compensation Insurer Must Pay for Gastric Bypass Surgery

August 4, 2008
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Related Topics: Medical Benefits Law, Benefit Design and Communication, Health and Wellness, Latest News
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An obese worker’s gastric bypass surgery is compensable under Oregon’s workers’ compensation law because the procedure was necessary to treat a job-related knee injury, an appeals court ruled Wednesday, July 30.

The ruling in SAIF Corp. and Jerry’s Specialized Sales v. Edward G. Sprague affirms a finding by the state Workers’ Compensation Board that SAIF Corp., a state-chartered workers’ comp insurer, must pay for the weight-loss surgery Edward Sprague underwent in 2001.

The ruling against SAIF and Jerry’s Specialized Sales stems from a knee injury Sprague first suffered in 1976. He reinjured the knee in 1999.

Doctors told Sprague his weight of 350 pounds would prevent successful treatment of the knee condition, so he sought workers’ comp medical benefits for the gastric procedure.

SAIF countered the claim was not compensable because the obesity was not caused by his 1976 accident. But the appeals court agreed with the comp board, which found the injury was more than a minor cause of the claimant’s need for gastric surgery and was therefore compensable.

Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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